Hot Topics:

Opinion: Guest Opinions

Elizabeth Crew: Colorado still lacks in-patient psychiatric care

By Elizabeth Crew

Posted:
05/10/2016 07:30:30 PM MDT

The July, 2012 Aurora theatre shooting that killed 12 and wounded 70 others generated intense scrutiny over Colorado's behavioral health-care system. There was a massive outcry from the citizens and legislature in the state of Colorado to offer more comprehensive and immediate mental health services to those in need.

In 2012, the state of Colorado ranked in the bottom half of the United States in per capita spending on mental health services and psychiatric treatment beds. At the time, only about one in seven people actually received behavioral health care, ranking Colorado sixth in the nation for suicide.

Colorado's answer to the problem was Senate Bill 13-266, which established crisis centers throughout the state, consisting of 24-hour telephone crisis response services, 24-hour walk-in crisis services and stabilization units, residential and respite bed facilities, mobile crisis services and a public awareness campaign.

It has now been a little over a year since the crisis centers opened and the question of how effective this bill has been looms in the air. Preliminary mandated reporting appears positive, with all of the four major agencies reporting an almost 100 percent rate of timely contact with clients, and three of the four organizations reporting a decrease in suicidal thoughts after contact with a crisis center.

Advertisement

Though initial self-reports appear promising, further investigation into these centers suggests a somewhat different story. The Colorado Department of Human Services contracted with the Western Interstate Commission for Higher Education (WICHE) to conduct an in-depth study of the state's current and future behavioral health care needs.

WICHE ultimately released a report of recommendations attempting to identify the largest and most pressing needs within the current behavioral health-care system. One major finding was that Colorado's ability to provide inpatient psychiatric care has decreased. They suggested an increase in the number of available beds, reallocating beds, or ensuring that the crisis centers effectively mitigate the need for more beds. The study also identified systemic barriers that block the delivery of behavioral health services, stating issues with allocation of responsibility as well as financing and funding concerns.

Nationally, there are 14 beds per 100,000 people; Colorado has 10 beds per 100,000. Psychiatric bed availability is a real problem in Colorado, especially within the crisis centers. Psychiatric emergency rooms reserve their beds for the most acute individuals, so a person who is thinking of harming themselves but perhaps does not have a plan, would likely be denied a bed. The responsibility of providing beds to these individuals ultimately falls on the crisis stabilization units, which do not have the capacity to adequately handle the demand.

Psychiatric beds are seen as being too costly, as the reimbursement of mental health services does not adequately meet the cost of treatment. The lack of state funding caused two state psychiatric hospitals to close, and the last remaining hospital to cut its available beds by almost 25 percent. With the responsibility now on the crisis centers, more state funding is needed to establish and maintain crisis stabilization units through the state.

The Colorado Department of Health Care and Policy Financing suggests funding be secured through the state's current Medicaid system. Its report proposes a change to the way Medicaid pays back organizations for mental health services. The current Colorado Medicaid system reimburses for services rendered on a capitation basis, or payment based as a set dollar amount per person. The proposed change would create a system of payment based on services rendered, making it so that providers can be paid back for more costly and extensive services.

Whether or not Colorado's Medicaid system changes, the behavioral health-care system in the state is in need of more psychiatric beds for those in need of immediate stabilization. Failing to address this need continues to put stress on an already overcrowded system and leaves vulnerable individuals in dangerous and even life-threatening situations.

Elizabeth Crew is studying for her master's degree in social work at the University of Southern California. She lives in Broomfield.

Clubs keeping eye on RPI rankingsIn the age of RPI (Ratings Percentage Index) determining playoff seeding in Colorado prep sports, playing a championship schedule has become more important than ever for any team expecting to compete for a state title. Full Story

The Boulder alt-country band gives its EPs names such as Death and Resurrection, and its songs bear the mark of hard truths and sin. But the punk energy behind the playing, and the sense that it's all in good fun, make it OK to dance to a song like "Death." Full Story